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Ventricular late potentials and myocardial fibrosis in hypertrophic cardiomyopathy

Ayumi Matsuki1, Tatsuya Kawasaki2, Hirofumi Kawamata2

  • 1Department of Cardiology, Matsushita Memorial Hospital, Osaka, Japan; Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Journal of Electrocardiology
|December 3, 2019
PubMed

Insights

Ventricular late potentials (VLPs) are not reliable for detecting myocardial fibrosis in hypertrophic cardiomyopathy (HCM) patients. Cardiac magnetic resonance (CMR) is a more accurate method for assessing fibrosis in this population.

Area of Science:

  • Cardiology
  • Biomedical Engineering

Background:

  • Ventricular late potentials (VLPs) reflect delayed cardiac conduction, often linked to myocardial fibrosis.
  • Hypertrophic cardiomyopathy (HCM) is a condition characterized by myocardial fibrosis and electrical abnormalities.

Purpose of the Study:

  • To investigate the relationship between signal-averaged electrocardiography (SAECG) findings, specifically VLPs, and myocardial fibrosis assessed by cardiac magnetic resonance (CMR) in HCM patients.

Main Methods:

  • The study included 41 HCM patients in sinus rhythm who underwent SAECG (measuring VLPs, filtered QRS duration, low amplitude signal duration [LAS], and root mean square voltage [RMS]) and CMR.
  • Cardiac magnetic resonance (CMR) utilized late gadolinium enhancement (LGE) to assess myocardial fibrosis.
  • The concordance rate between VLP detection and LGE findings was analyzed.

Main Results:

  • Late gadolinium enhancement (LGE) was detected in 13 patients, and VLPs in 14. SAECG parameters (filtered QRS duration, LAS, RMS, VLPs) did not correlate with LGE.
  • Concordance between LGE and VLPs was observed in 26 patients, with 15 showing discordance.
  • Discordant patients exhibited greater maximum wall thickness, higher LGE volume, and predominant LGE in the interventricular septum and anterior wall compared to concordant patients.

Conclusions:

  • Ventricular late potentials (VLPs) are not a dependable marker for identifying myocardial fibrosis in HCM patients when assessed by LGE on CMR.
  • SAECG, including VLPs, is not a substitute for CMR in the evaluation of myocardial fibrosis in HCM.
Abstract

Keywords:
Hypertrophic cardiomyopathyLate gadolinium enhancementLate potentialsMyocardial fibrosis

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